JAAD onlineTherapeutic pearlTopical timolol for chronic wounds in patients with junctional epidermolysis bullosa
Section snippets
Therapeutic challenge
Junctional epidermolysis bullosa (JEB) is characterized by skin cleavage occurring within the lamina lucida of the basement membrane zone. Patients with the generalized intermediate subtype of JEB have relatively mild skin fragility but develop painful chronic wounds in the periorificial areas, nail beds, and flexures because of mutations in one of the genes encoding for laminin 332. Topical steroids are usually applied, but this treatment is often insufficient.
Solution
Two 1-year-old children with the generalized intermediate subtype of JEB had chronic wounds of the nail bed and neck fold, respectively, despite the daily application of potent topical steroids and protection with silicone dressing for >2 months. After 3 and 8 weeks of twice daily topical application of 2 and 3 timolol maleate 0.5% LP eye drops under occlusion (Mepiform; Mölnlycke Health Care, Norcross, GA), respectively, healing was obtained at 100% and 80% (Fig 1). No adverse effects were
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Funding sources: None.
Conflicts of interest: None declared.